doppler echo & colour doppler -fazil bishara. blood is not a uniform liquid blood flow is...
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ECHO BASICS-3
Doppler echo & colour doppler
-fazil bishara
Properties of blood
Hemodynamics- physical principles of blood flow & circulation
Density – mass per unit volume( g/ml) Viscosity – ability of molecules to move
past one another by overcoming frictional forces ( 0.035 poise at 37◦c)
Flow occurs from high pressure to low pressure end
Factors determining flow
Flow rate is determined by Pressure gradient Resistance
Viscosity of blood Radius of lumen Length of vessel
R= 8Lv/ ∏r4 V viscosity of blood R radius of lumen L length of the vessel
Q= ∆P/R
Types of flow
Laminar flowShape of parabolaConcentric layers , each parallel to vessel
wallVelocity of each layer differsMaximal velocity is at centre of vesselDecreasing profile towards peripheries
Laminar flow
Acceleration of flow- flat flow profile / plug flow
Converging flow- flat profile parabolic profile
Diverging flow - multiple flow patterns(uniform high velocity flow, stagnant flow, eddy flow)
Vessel curvature – high velocity in the inner part of curve in the ascending limb, outer part of the curve in descending limb
Types of flow
Turbulent flow
Obstruction produce increased velocities, flow vortices
Whirlpools shed off in different directions producing variable velocities- chaos
Predicted by Reynolds number Reynolds number depends on
Re=( ρ x c x D)/v ρ-Density of bloodD-Vessel diameterc-Velocity of flowV-viscosity
The Reynolds number is dimensionless
If Re is less than 1200 the flow will be -laminar
1200-2000 flow is described as -transitional
Greater than 2000 -turbulent
Doppler Principle
First described by Johann Christian Doppler, an Austrian mathematician and scientist who lived in the first half of the19th century.Doppler’s initial descriptions referred to changes in the wavelength of light as applied to astronomical events.
In 1842, he presented a paper entitled "On the Coloured Light of Double Stars and Some Other Heavenly Bodies" where he postulated that certain properties of light emitted from stars depend upon the relative motion of the observer and the wave source.
BASIC PRINCIPLES A moving target will backscatter an
ultrasound beam to the transducer the frequency observed when the target
is moving toward the transducer is higher the frequency observed when the target
is moving away from the transducer is lower than the original transmitter frequency
Doppler effect
The phenomenon called doppler effect!
When a whistle blowing train passes a stationary listener, the sound pitch is higher as the train approaches and lower as the train passes…
Doppler shift represents difference between received and transmitted frequencies ,which occur due to motion of RBC’s relative to the ultrasound beam
Fd = (2f V cos Ø)/C
Doppler shift (F[d]) = F[r] - F[t]
F[d] = (2f[t] V cos Ø)/C
Blood flow velocity (V) speed of sound in blood (C) ø, the intercept angle between the ultrasound beam A factor of 2 is used to correct for the "round-trip"
transit time to and from the transducer.
Why the factor 2?
Double doppler shift
1st shift-transducer stationary source,RBC the moving receiver
2nd shift is when,RBCs are moving source and transducer is the stationary receiver.
This equation can be solved for V, by substituting (F[r] - F[t]) for F[d]:
V = [(F[r] -F[t]) x C] ÷ (2 x F[t] x cos ø) the angle of the ultrasound beam and the direction of
blood flow are critically important in the calculation ø of 0º and 180º (parallel with blood flow), cosine ø = 1 ø of 90º (perpendicular to blood flow), cosine ø = 0 , the
Doppler shift is 0 ø up to 20º, cos ø results in a <10 percent change in the
Doppler shift ø of 60º, cosine ø = 0.50
Angle of doppler beam in relationship to direction of blood flow
The Effect of Angle
Angle Cosine Percentage error0 1 010 0.98 220 0.94 730 0.87 1360 0.5 5090 0 100
Angle correction
It is possible to correct for angle, in clinical practice.
However, Not recommended as in most cases it is possible to align ultrasound beam parallel by using multiple echo views.
It is assumed that angle between ultrasound beam and direction of blood flow is parallel
Effect of frequency
Lower the frequency, higher the velocity detected
A 2 MHz transducer detects higher velocity compared to a 5 MHz transducer
The spectral doppler display
Is a graphic display of blood flow velocities plotted over time.
Spectral analysis — the difference between the transmitted
and backscattered signal is determined by comparing the two waveforms with the frequency content analyzed by fast Fourier transform (FFT). The display generated by this frequency analysis is termed spectral analysis
2 methods used to calculate the frequency content of a doppler signal
1. Zero-crossing method2. Fourier analysis
Sine wave crosses the zero line twice, frequency calculated as no of zero crossings divided by 2
unfortunately the returning signal is not a pure sine wave but is a complex wave, hence the technique not used
Fourier analysis done using a computer algorithm called FFT that uses a mathematical tool to extract frequency information from signals
Many sequential FFTs are performed to generate and display a doppler.
Information displayed include- 1.flow velocity 2.flow direction 3.signal timing 4.signal intensity
Flow velocity
Displayed on y axis
Velocity of RBCs within sampled volume is calculated
Absence of velocity-zero baseline
Direction of flow
Flow direction also displayed on Y axis
Positive doppler shift-flow towards transducerTraditionally displayed above baseline
Negative doppler shift-flow away from transducerDisplayed below zero baseline
Timing
Time is displayed along x axis
Displayed along with ECG.
Change in blood velocity , flow direction can be accurately timed in relation to cardiac cycle.
Intensity or amplitude
Blood cells do not move at equal velocities
Produce different frequency shifts Amplitude or intensity of doppler signal
reflects the number of blood cells moving within a range of velocities at a particular point of time
Bright signal-strong doppler shift frequency at a particular point of time .
Darker regions-weak doppler shift
Spectral velocity recordings
Doppler Audio signals
Doppler shift frequencies are in audible range
Guide for localising blood flow and for proper aligning ultrasound beam parallel to flow
Laminar flow-smooth tone
Turbulent flow-harsh sound.
Pulsed and Continuous Wave Doppler
Continuous Wave Doppler
older and electronically more simple continuous generation of ultrasound waves continuous ultrasound reception two crystal transducer Blood flow along entire beam is observed
ADVANTAGEability to measure high blood velocities accurately
DISADVANTAGE1)lack of selectivity or depth discrimination2)no provision for range gating to allow selective placing of a given Doppler sample volume in space
Pulsed Wave Doppler
Ultrasound impulses are sent out in short bursts or pulses
transducer that alternates transmission and reception of ultrasound
ability to provide Doppler shift data selectively from a small segment along the ultrasound beam- sample volume can be selected.
The transducer does not emit ultrasound continuously, but rather, emits pulses
rapidly (approximately 1,000 pulses per second)
&
quickly (approximately 1 microsecond for every pulse).
Therefore, the transducer is operating as a transmitter for an extremely short time (0.1% of the time).
The transducer functions as receiver for a limited time period
Time corresponds to the interval required for sound to return from specified area.
Another burst of sound waves are not transmitted until previous impulses are received.
Pulse repetition frequency (PRF)–frequency at which transducer transmits pulses.
PRF determines sampling rate.
Sample volume
three-dimensional, teardrop shaped portion of the ultrasound beam
width is determined by the width of the ultrasound beam at the selected depth.
length determines the length of time that the transducer is activated to receive information from sv location
Sampling rate/frequency- the number of digital points sampled per sec.
Nyquist frequency- the highest frequency in a signal
Nyquist rate- the minimum sampling rate at which the signal could theoretically be recovered, which is twice the nyquist frequency.
Nyquist limit- the max. detectable frequency shift, which is one half the PRF.
Fig.1.24
Aliasing
The aliasing phenomenon occurs when the velocity exceeds the rate at which the pulsed wave system can record it properly
Inability to accurately measure high blood flow velocities- aliasing
Aliasing is represented on the spectral trace as a cut-off of a given velocity with placement of the cut section in the opposite channel or
reverse flow direction
Nyquist Limit
The Nyquist limit defines when aliasing will occur using PW Doppler.
The Nyquist limit specifies that measurements of frequency shifts (and thus the velocity) will be appropriately displayed only if the pulse repetition frequency (PRF) is at least twice the maximum velocity (or Doppler shift frequency) encountered in the sample volume.
Shannon's sampling theorem(Claude E. Shannon, born 1916, American mathematician) Also known as the Nyquist criterion, a general "rule" for measurement of frequencies, stating that the measurement (sampling) frequency must be at least twice the maximum frequency to be measured. Whenever Shannon's sampling theorem is not fulfilled, aliasing occurs
Nyquist limit specifies the maximum velocity that can be recorded without aliasing.
Avoiding aliasing
Increase the Nyquist limit-
1)altering variables in Doppler equation 2)high PRF mode3 )Change from PW to CW
V = C × PRF4 f COS Ø
Max velocity can be increased by1)Increasing PRF2)Decreasing transmitted frequency3)Increasing speed of sound in tissue4)Decreasing cosØ
Increasing the PRF D = c t /2 ; D =distance to the structure/region of
interest c = propagation speed through tissue t = time taken for US signal to return to
the transducer 2 because pulse must travel to the
structure & then back again
Decreasing the transmitted frequency
Selection of a lower frequency transducer , increases the max.velocity detected at any depth.
Introducing an offset
Electronic cut and paste
Moves the aliased doppler signal upward or downward(unwrapping)
Repositioning baseline effectively increases the maximum velocity at the expense of other direction.
Baseline shift ("zero shift" or "zero off-set")
Repositioning of zero baseline effectively increases the maximum velocity in one direction, at the expense of other direction
Utilizing high PRF mode
A higher than normal PRF used here using multiple sample gates at various locations.
Transmission of any given pulse occurs before the reception of all the echoes from the previous pulse.
Drawback- exact location of the doppler shift is not known!
Changing from PW to CW
Aliasing not a problem here as sampling limitations does not occur with CW.
Limitation- NO range resolution!
Comparison between CW & PW
cw pw
Depth resolution no yes
Sample volume large small
Detection of high velocities
yes no
Aliasing no yes
Spectral content Wide narrow
Use in duplex instruments
yes yes
sensitivity more less
Transducer power Lower Higher
Control Of Sample Volume Placement
Poor Good
When a specific area of abnormal flow is to be located - PW Doppler is indicated.
When accurate measurement of elevated flow velocity is required- CW Doppler should be used
Optimization of doppler signals
1. Angle dependency2. Sample volume position3. Velocity scale & baseline4. Wall filters 5. Gain6. Sample volume length7. Electrical versus mechanical events
Basic principles of colour doppler imaging
Doppler images produced by using multiple sample gaits along multiple scan lines
The device that detects doppler shift frequency is the AUTOCORRELATOR
Where doppler signals are detected, pixels representing that areas are designated a colour, which is determined by the mean doppler shift detected at that site.
Colour coding relative to the transducer is direction sensitive
The colour doppler display
Blood flow direction – BART system Blood flow velocity- low velocity flow
indicated by colours closest to colour baseline - Appear in deeper colour hues - High velocity flow – towards the end of
colour bar, appears brighter - No angle correction -Peak velocity estimations are not possibe -Only mean doppler velocities are depicted
Frequency aliasing -appears as colour reversal.
normal blood flow velocities rarely cause aliasing in PW doppler, but frequently in CFI.
Laminar vs turbulant flow – smooth homogenous pattern; RBCs move at about the same velocity & in the same general direction
Turbulant flow- disorganised mosaic pattern containing all colours on the colour bar
Optimisation of colour flow doppler images
Frame rate- no of frames produced per second
Depends upon -depth colour sector width line density Velocity scale- adjusts the maximum
mean velocity that can be displayed Wall filters Gain
references
Figenbaum, H : echocardiography Bonita anderson- ECHO Hand book of echo doppler- kerut Moss and adams Otto clinical echocardiography